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A man who has an uncontrollable laugh - compared to Arthur Fleck in Joker - has revealed what it's like living with the condition.
Scott Lotan, from Virginia Beach in the United States, has a rare pathological disorder that leaves him unable to stop himself from laughing regardless of the situation he's in, much like Joaquin Phoenix's character in the 2019 superhero movie.
In Mr Lotan's case, the pseudobulbar affect (or PBA) is a symptom of his multiple sclerosis which causes him to have laughing episodes that can last up to 10 minutes at a time, and which he is completely powerless to stop.
But as well as being physically exhausting and painful, the rare condition has led to numerous uncomfortable encounters for Mr Lotan and has even resulted in people wanting to fight him due to his uncontrollable laughter.
Speaking to LADbible, he said: "I have had issues with not being served at restaurants and been asked to leave because waitstaff were uncomfortable.
"Many times if I am out for a drink with friends, there is someone with low self-esteem that believes I am laughing at them and they will try and start a fight."
But Mr Lotan's PBA was never less welcome than in the aftermath of a tragic crash in 2003.
He said: "We were leaving my engagement party and were hit by a drunk driver. My fiancée died at the scene with my mother's death three days later.
"I remember being at the scene laughing and being questioned by police.
"At the wakes for both my mother and my fiancée I would have to separate myself from everyone as I would burst into laughter at times.
"I try to be fully aware of myself and I understand that it's beyond my control, but knowing that others think you are a freak and always explaining to people I am not this emotionally void psychopath can be difficult."
The 2019 release of Joker shone a spotlight on the broadly misunderstood disorder, and while many viewers have reported feeling empathetic towards Joaquin Phoenix's Arthur Fleck, for Mr Lotan it was like looking in a mirror.
He said: "I think he did a great job of capturing the inability to stop laughing no matter what the circumstances are. I felt as if he experienced a deep sense of rejection in the bus scene, similar to how I felt during the days of my accident.
"It weighs heavy on the mind, people just look at you. You try and explain but they have preconceived notions that you are a drug addict or just a deranged lunatic. I think he captured the feeling of isolation and frustration with the lack of understanding from others.
"At times during the film I felt as though I was looking at a reflection of myself."
Mr Lotan added that Phoenix's portrayal of the disorder was accurate, right down to the uncomfortable choking during laughing episodes.
He said: "The choking comes from trying to catch my breath, desperately needing to breathe. Also, spit builds up in your mouth and as you pull in a breath the spit goes down the wrong pipe.
"My neck gets really sore and I am moving my head to try to relieve strain and sometimes that cuts off air."
Videos of Mr Lotan experiencing such episodes have previously gone viral, and while PBA has caused him a great deal of suffering, he is keen to emphasise that his life is not all doom and gloom.
He said: "There are a lot of comments of empathy [online], and although they are offering well wishes, they also seem to think I am living this horrible life filled with pain and suffering.
"Just like anyone else I have my ups and downs - sure, at times I laugh uncontrollably, but there could be much worse things to happen.
"For the most part it turns into a humorous thing when interacting with my kids."
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